Individual
JENNIFER LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, MSW
Contact information
Practice address
5364 W COBBLESTONE ST, BLOOMINGTON, IN 47403-8204
(920) 366-1698
Mailing address
5364 W COBBLESTONE ST, BLOOMINGTON, IN 47403-8204
(920) 366-1698
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
33011757A
IN
Other
Enumeration date
10/18/2023
Last updated
10/18/2023
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